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Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children

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  • University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh

Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case–control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28–0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24–35 months of age (OR = 8.2, 95% CI = 4.3–15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3–23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.

Author Notes

* Address correspondence to Oscar Colin Stine, University of Maryland School of Medicine, 660 West Redwood Street Howard Hall Room 585, Baltimore, MD 21201. E-mail: ostin001@umaryland.edu

Financial support: This research was funded by Bill & Melinda Gates Foundation awards: BMGF 38874 to Myron M. Levine, Karen Kotloff, and James P. Nataro, BMGF OPP42917 to James P. Nataro and and Oscar Colin Stine, BMGF OPP1016839 to James P. Nataro and Oscar Colin Stine.

Authors' addresses: Brianna Lindsay, Tamar H. Farag, Dilruba Nasrin, Shan Li, Sandra Panchalingam, Myron M. Levine, Karen Kotloff, Laurence Magder, Laura Hungerford, and Oscar Colin Stine, University of Maryland School of Medicine, Baltimore, MD, E-mails: brlindsay@gmail.com, tamer.farag@gatesfoundation.org, dnasrin@medicine.umaryland.edu, sli1@epi.umaryland.edu, spanchal@medicine.umaryland.edu, mlevine@medicine.umaryland.edu, kkotloff@medicine.umaryland.edu, lmagder@epi.umaryland.edu, lhungerf@epi.umaryland.edu, and ostin001@umaryland.edu. Debasish Saha, Medical Research Council Unit, Basse, The Gambia, E-mail: Debasish.x.Saha@GSK.com. Doh Sanogo, Center for Vaccine Development, Bamako, Mali, E-mail: anogodoh@yahoo.fr. Sumon Kumar Das and M. Anowar Hossain, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: sumon@icddrb.org and anowar@icddrb.org. James P. Nataro, University of Virginia, Charlottesville, VA, E-mail: jpn2r@hscmail.mcc.virginia.edu. Richard Omore and Joseph Oundo, Kenya Medical Research Institute (KEMRI)-US Centers for Disease Control and Prevention Research Collaboration, Kisumu, Kenya, E-mails: romore@ke.cdc.gov and joseph.oundo@usamru-k.org. Mitchell Adeyemi, Medical Research Council Unit, The Gambia, E-mail: adeyemimitchell@yahoo.com. A. S. G. Faruque, Centre for Nutrition and Food Security, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, E-mail: gfaruque@icddrb.org.

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